title: Candida non-albicans versus Candida albicans fungemia in the non-neonatal pediatric population.
abstract: BACKGROUND
  Non-albicans Candida (NAC) species have been implicated as major pathogens in patients with hospital-acquired candidemia. Few studies have investigated the impact of NAC fungemia among pediatric patients outside of the neonatal age group.
  
  
  METHODS
  Between 2000 and 2009, we performed a retrospective case-control study in children aged 6 months to ≤18 years with blood culture proven candidemia at Texas Children's Hospital, Houston, TX.
  
  
  RESULTS
  A total of 276 episodes of candidemia occurred in 226 patients. The overall incidence ranged between 0.06 and 0.3 per 1000 inpatient days. The median patient age was 50 months (range, 6 months to ≤18 years) with 55.4% males; 40.2% Hispanics; and 31.8% whites. Candida albicans (CA) was the most common (44.2%) species although, collectively, NAC was more frequently (55.8%) isolated. Among the NAC group, Candida parapsilosis was most common (23.9%) followed by Candida tropicalis (14.8%), Candida glabrata (6.5%), and Candida lusitaniae (5.4%). No difference was found between CA and NAC candidemia in terms of demographics, underlying diagnosis, risk factors, clinical features, dissemination, or 30-day mortality. Disseminated candidiasis was independently associated with the use of vasopressors (adjusted odds ratio [OR], 4.58; confidence interval [CI]: 1.03-20.5; P = 0.05), prolonged fungemia (≥3 days of persistently positive cultures) after catheter removal (OR, 3.2; CI: 1.08-9.3; P = 0.04), and neutropenia (OR, 4.06; CI: 1.2-13.2; P = 0.02), but not with NAC fungemia.
  
  
  CONCLUSIONS
  Though CA was the single most common species, NAC species collectively have emerged as the predominant pathogens responsible for candidemia in non-neonatal patients at our institution. Risk factors, clinical features, and outcomes were not different between the 2 groups.
authors.affiliation: Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA. ankhidutta@gmail.com
authors.forename: Ankhi
authors.initials: A
authors.lastname: Dutta
authors.forename: Debra L
authors.initials: DL
authors.lastname: Palazzi
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002175:Candida / Q000145:classification* / Q000302:isolation & purification*; D058387:Candidemia / Q000453:epidemiology* / Q000382:microbiology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology